№ 4 (2014)

The prevalence of nocturnal enuresis in children aged 5 to 15 years is 10-15 % [1]. The main causes of nocturmal enuresis include pathologies of the central nervous system, bladder dysfunction, and nocturnal polyuria [1, 2]. The recent studies have revealed an important role of changes in the regulation of kidney function in the pathogenesis of nocturnal enuresis. This is due to two factors; one of them is the reduction of vasopressin secretion by the pituitary gland, and another - increased renal secretion of autacoids, a local antagonists of antidiuretic hormone, which can cause an increase of nocturnal diuresis [3, 5].

Urinary tract infection (UTI) is a frequent gestational complication. During pregnancy, lack of timely and adequate treatment of lower UTI leads to the development of gestational pyelonephritis, miscarriage, and perinatal morbidity. Highly virulent uropathogenic flora, limitation in the choice of antibiotics and increasing antibiotic resistance of microbial agents create difficulties in sanitation of the urinary tract during pregnancy. Fosfomycin trometamol (Monural) was applied in 85 pregnant women with UTI in the 2nd and 3rd trimesters, and has proved high efficacy in the sanitation of lower urinary tract in single dose and effective prevention of relapse of chronic pyelonephritis with repeated dosing.

The study involved 73 patients from different regions of the Russian Federation in age from 20 to 65 years (mean age - 34.32 ± 7.9 years) with various types of pathospermia and duration of infertile marriage from 14 months to 4 years (mean duration 22.27 ± 17.1 months). These patients were divided into two groups with the presence of anti-sperm antibodies (ASAB), and without them; in patients with ASAB, subgroup with clinically significant ASAB levels more than 10 % was further identified. All patients received AndroDoz ® for 3 months. All patients underwent spermatologic control, monitoring of blood and urine tests, blood biochemistry and hormones, the evaluation of antisperm antibodies levels, and immunoglobulins A and G levels. After 3 months of therapy, it was found that patients receiving AndroDoz ® had significantly reduced viscosity of spermoplasma, especially patients with ASAB.vAt the same time, patients with ASAB had decreased sperm agglutination by 80.1 % (P = 0.0001), increased total number of actively motile sperm cells (A + B), and decreased number of pathological forms of sperm cells by 26.32 % (P = 0.0001, with normalization of this index in 100% of patients with an initial critical increase ( > 96 % abnormal forms) at the end of therapy). Moreover, patients receiving AndroDoz® had significantly increased Inhibin B levels. At the end of the course of therapy, 87.6 % of patients have reported good and pronounced effect of the treatment. AndroDoz® has shown to be effective in treating infertility and pathospermia of various origins with a high degree of reliability of the results.

There is unsettled controversy about the respective efficacy and safety of 200 and 600 mg mifepristone in combination with two prostaglandins for the termination of pregnancy up to 63 days’ gestation. We performed a meta-analysis of randomized controlled trials (RCTs) of direct comparisons between the two dose regimens. End points were complete abortion, continuing pregnancy and side effects. Four RCTs (3482 patients) were found. Noninferiority of 200 mg mifepristone compared with 600 mg was proven for complete abortion (difference, 0.4 %; 95 % confidence interval [CI] = -1.4 % to 2.3 %). Noninferiority was not proven for continuing pregnancy (difference, 0.4 %; 95 % CI = -0.3 % to 1.0 %). Two hundred milligrams may therefore result in 1 % more continuing pregnancies than 600 mg when used with the approved prostaglandin regimens. Sensitivity analyses confirmed the findings. There was no difference in adverse events between both doses of mifepristone. Although 200 or 600 mg of mifepristone with two prostaglandins probably results in similar rates of complete abortion, the substitution of 200 mg for 600 mg may lead to an increased continuing pregnancy rate.

To improve the quality of conservative treatment of mild cervical intraepithelial pathology, the randomized, stratified use of different treatment regimens with the identification of molecular marker p16INK4a in women of early reproductive age as a method of monitoring the effectiveness of drugs, along with liquid-based cytology and HPV-testing was performed. The study involved 434 patients with HPV-associated cervical pathology at the age up to 29 years. An algorithm for the management of patients with HPV-infection with the recommendations for the use of drugs containing glycyrrhizic acid and ribavirin («Devirs» ®) for topical application was developed.

Diagnosis of cancer during pregnancy is the dramatic event and difficult dilemma for the pregnant woman, her family and physicians. In the last decade, combination of malignancies with pregnancy becomes less rare event with a frequency of occurrence of 0.05 to 0.10 % of pregnancies. This is due to the postponement of childbearing age, and some decrease in cases of malignant tumors. The most frequent neoplasma, combined with pregnancy, is preinvasive cervical cancer (cervical intraepithelial neoplasia, CIN). The article is dedicated to the review of permissible methods of diagnosis; a possible treatment strategy for patients in accordance with international recommendations and the Russian experience is suggested.

Tobacco smoking in women of reproductive age, including pregnant women, leads to declines in their health, complications of pregnancy and childbirth, and poor outcomes for the fetus and newborn. In Russia, 25-30 % of women smoke during pregnancy. Strategies for successful smoking cessation are developed, one of which is presented in this review («5A» method); they are not integrated, however, into the daily practice of the obstetrician-gynecologist. At the same time, measures aimed at smoking cessation, allow to achieve reduction in the number of pregnant smokers at 80 %, which has a significant impact on pregnancy outcomes and substantially reduces the healthcare costs (20-fold excess of savings over the financial resources expended on this work).